We wouldn’t blame you if even hearing the words “testicular trauma” makes you shudder. No guy wants to think about getting hit in the most sensitive part of the body.
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We wouldn’t blame you if even hearing the words “testicular trauma” makes you shudder. No guy wants to think about getting hit in the most sensitive part of the body. But luckily, many testicular injuries are minor and can heal without medical treatment.
Sports injuries and motor vehicle accidents are among the most common causes of testicular trauma. (In other words, this isn’t just generic testicle pain.) Due to the mobility of your testicles inside your scrotum, catastrophic injury is usually avoidable, even when you receive a direct blow to the groin. But some people still develop a complete rupture of the testicle, which requires surgical repair.
Read on to learn more about testicular trauma, including causes, symptoms, diagnosis, and treatment options.
The most obvious symptom of testicular trauma is pain around your testicles or scrotum (more commonly called your ballsack). Pain is often severe due to the high concentration of nerves in this area. Other symptoms you develop might depend on your type of injury.
The three main categories of injuries are:
Blunt scrotal trauma
Penetrating scrotal trauma
Degloving injuries
Here’s a breakdown of potential symptoms by trauma type.
Blunt trauma is a sudden impact to your testicles that doesn’t penetrate the skin, such as a knee to the groin during a basketball game or a serious bump from your bicycle seat. About 50 kilograms (roughly 110 pounds) of direct force can cause a testicle rupture.
Signs and symptoms of blunt trauma might include:
Sudden and severe testicular pain
Scrotal swelling
Discoloration
Nausea and vomiting
Hematoma or bruise (contusion)
Tenderness to the touch
Difficulty walking or moving normally
Hematocele (blood pooling around the testicle)
In the past, about 75 to 80 percent of cases of genital injuries were thought to be caused by blunt trauma. But a 2018 U.S. study found blunt and penetrating scrotal injuries now occur in nearly equal numbers. This shift may be due to reporting differences or factors like the higher rate of gun-related injuries in the U.S. compared to other countries.
Penetrating trauma occurs when an object goes through your skin, such as stab wounds or gunshots. These injuries are medical emergencies. Severe injuries can cause bleeding or may put you at risk of losing one or both of your testicles.
Symptoms might include:
Severe pain
Bleeding from the scrotum and possibly surrounding tissues
Visible puncture wound
Exposure of testicular tissue
Loss of testicular shape
Blood in your urine (if your urinary tract is affected)
Possible shock, in severe cases
Degloving injuries are severe and often require reconstructive surgery, but luckily, they’re rare. They occur when the skin of your scrotum is torn away from your body. Degloving is often associated with the use of heavy machinery. For example, in a 2020 case study, researchers reported an instance of a degloving injury in a man operating a tractor.
Signs and symptoms might include:
Extensive pain
Complete or partial loss of scrotal skin
Exposed testicles
Bleeding and soft tissue damage
Signs of an infection such as discoloration or a foul odor
Shock (due to blood loss or pain)
Complications of testicular trauma can cause additional symptoms. Here’s a look at some of the potential concerns.
A testicular rupture occurs when the outer layer of your testicles (tunica albuginea) is torn away from its usual place and the inner components are exposed. A rupture may occur due to severe blunt trauma or penetrating injuries. It’s a medical emergency that requires immediate attention.
The symptoms of testicular rupture are the same as those for testicular trauma but generally more severe.
Infections can occur if bacteria get into open wounds left by penetrating injuries. Inflammation and infections in a testicle are called orchitis, or epididymitis when they occur in the epididymis, where sperm is stored.
Symptoms can include:
Gradual onset of pain
Swelling and redness in your scrotum
Warmth or tenderness around your scrotum
Fever and chills
Painful urination or discharge
Testicular dislocation is a rare injury where your testicle becomes displaced from its normal location. Along with pain, you may notice:
Your testicle is missing from your scrotum
A lump above your pelvis
Nausea and vomiting
Testicular torsion is a medical emergency that occurs when the spermatic cord connecting your testicle to your body becomes twisted around itself. This twisting can lead to a loss of your testicle’s blood supply if the blood vessels are completely compressed.
It’s a medical emergency that requires immediate attention to restore blood flow to your testicle. Acting fast is critical. If treatment happens within six hours after your symptoms start, there’s nearly a 100 percent chance of saving your testicle. But after 12 to 24 hours, that chance drops to less than 50 percent.
Severe injury can lead to infertility if your testicles are severely damaged. It’s still possible to father children if you only have one testicle, but if both testicles are removed or severely damaged, you may no longer be able to have children.
Genitourinary injuries (referring to injuries to your genitals and urinary tract) are more common in males than females due to the penis and testicles being outside of the body.
Although the structures in your testicles are easily injured, the mobility of your testicles inside your scrotum often helps protect them from serious injury.
Here’s a look at some of the most common causes of testicle injury.
Up to 80 percent of cases of genital trauma may be caused by blunt trauma.
Sports injuries are thought to be the most common cause of testicular trauma. It may occur after:
Kicks, punches, or knees to the groin
Balls striking your groin
Tackling that compresses your testicles
Somebody falling on your groin
Sudden impact from a bike seat or bike frame
Landing on your testicles after falling on a structure such as a balance beam
Motor vehicle crashes are the second most common cause after sports injuries. Your testicles might get compressed from a collision or after falling off a vehicle such as a motorcycle.
Other causes of blunt testicular trauma can include:
Sudden impact of the saddle to your groin when horseback riding
Animal kicks or attacks
Falls
Physical assault
Industrial or workplace accidents
Rough play or accidents, such as trampoline mishaps, jumping off furniture, or playground collisions
Dropping heavy objects onto your groin
Accidental contact during sexual activity
Research suggests that penetrative injuries are more likely to affect both testicles than blunt trauma. Potential causes include:
Stab wounds from knives, scissors, or sharp objects during assaults or accidents
Gunshot wounds, or wounds from other high-velocity projectiles
Glass or metal shard injury, from broken windows, car accidents, or explosions
Animal bites, from dogs or wild animals
Puncture by construction tools, such as nails, screws, or rebar
Arrow or spear injuries, during sport or hobby use
Shrapnel injury, from explosions, fireworks, or military combat
Falling onto sharp objects, such as the top of a fence, exposed metal rods, or garden tools
Self-inflicted injury
Potential causes of degloving injuries include the following:
Industrial machinery accidents, such as when your clothing or body is pulled into rotating machines
Motorcycle or bicycle accidents that cause sliding against pavement
Other falls onto rough surfaces
Farm equipment injuries
Auto crashes, especially if you’re ejected from your vehicle or dragged during a collision
Crush injuries that cause heavy objects to fall on your groin with friction
Severe animal mauling, especially by large animals like bears
Severe assault
Testicular trauma can happen to anybody, but certain factors may increase your risk.
Age. Younger males are generally more likely to participate in sports than older males and generally have higher rates of motor vehicle accidents than middle-aged adults.
Contact sports participation. Participating in contact sports like football, rugby, martial arts, and hockey comes with a risk that somebody might fall on or otherwise hurt your testicles. Sports injuries make up more than half of testicle injuries.
Lack of protective gear during sports. Wearing a cup or other supportive clothing during athletic events can potentially prevent trauma to your testicles.
High-risk occupations. People in fields such as construction, manufacturing, farming, or mechanical work may be at an increased risk of industrial accidents that affect the testicles.
Extreme sports or recreational activities. Participating in some extreme sports or activities that come with a high risk of injury, like jumping off high structures during parkour without proper training, may also increase your risk of testicular injury.
Violent environments. Being in an environment with an increased risk of assaults, fights, or gunshot wounds puts you at risk of testicular injury.
Risk-taking behavior. Performing needless stunts, reckless driving, or other aggressive activities can increase your risk of testicular injury.
Most people receive a diagnosis for testicular trauma after they visit their healthcare provider or the emergency room due to sudden testicular pain, usually after a memorable injury.
When determining the extent of your injury, your doctor will start by:
Reviewing your medical history
Reviewing your symptoms and the nature of your injury
Performing a physical examination to look for signs of trauma, which may be difficult to complete due to scrotal tenderness.
If your doctor thinks there could be serious damage to your testicle, or if it’s not clear if your pain was caused by a particular injury, they may order imaging tests such as Doppler ultrasound (ultrasonography). This test allows doctors to accurately diagnose testicular rupture more than 95 percent of the time.
Less commonly, you may receive an MRI to look at the internal structure of your testicle.
The best type of treatment for your injury depends on the extent of damage to your testicle. Here’s a look at potential treatments based on injury severity.
Minor testicular trauma can often be treated at home with remedies such as:
Rest and scrotal elevation
Ice packs for 20 to 30 minutes at a time, up to 3 to 4 times per day
Supportive underwear or athletic supporter to prevent movement of your scrotum
Ibuprofen (Advil) or acetaminophen (Tylenol) for pain relief
Injuries caused by severe blunt trauma might need treatment with:
Surgery to repair a rupture or to stop bleeding
Partial orchiectomy, the removal of part of a testicle
Total orchiectomy, the removal of an entire testicle, if it isn’t salvageable
Outcomes are the best for ruptures when you have surgery within 72 hours of your injury.
Penetrating injuries generally have a higher risk of complications than blunt trauma injuries. You may receive:
A tetanus shot to prevent tetanus before it occurs
Antibiotics to treat or prevent infection
Urgent surgical exploration and repair
Removal of your testicle or testicles if they can’t be saved
Treatment for degloving injuries may include:
Emergency surgical repair
Reconstructive surgery or skin grafting of the scrotum
Antibiotics and a tetanus shot to prevent infection
You may need to follow up with medical professionals such as specialists in urology after your injury. Tests you may receive at your follow-up appointments include:
Ultrasounds to monitor healing
Fertility evaluation to see if you’re still able to have children
Counseling for emotional or psychological trauma
Testicular prosthesis surgery after the removal of one of your testicles
While you may not be able to avoid all testicular trauma, here are some general ways you can lower your risk:
Wear a protective cup. It’s especially important to wear a cup when playing contact sports with a high risk of testicular injury, such as football, hockey, and baseball.
Be cautious around machinery. Follow proper safety protocols in industrial settings when using machinery that could damage your genitals.
Sit properly on bikes and consider a gel seat cushion. Adjust the height of your bicycle seat to reduce groin pressure. Padded bike seats can help, too.
Follow OSHA or safety guidelines. Stay up-to-date on safety training in the workplace.
Don’t take unnecessary risks. Be cautious in crowded or active areas where sudden impact might occur, such as when walking somewhere you could slip and hit your groin.
Take precautions when on the road. When in a motor vehicle, wear a seatbelt when available. When riding a motorcycle, make sure you wear proper protective clothing.
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